Center for Diagnostic and Therapeutic Endoscopy, Keio University, Tokyo, Japan.
Dig Endosc. 2010 Oct;22(4):316-8. doi: 10.1111/j.1443-1661.2010.01011.x.
A 51-year-old man was referred to our hospital because of duodenal lesions of lymphoma. Endoscopy showed multiple tiny smooth whitish granules in the second portion of the duodenum including the papilla of Vater. Biopsy specimens showed medium-sized centrocyte-like cells forming lymphoid follicles, and immunohistology showed positive staining for bcl-2 and CD10. A small bowel series showed multiple granular lesions extending from the second portion of the duodenum to the proximal jejunum and the proximal ileum. On the basis of these findings, the tumor was diagnosed as stage I follicular lymphoma (FL). Although the patient was negative for Helicobacter pylori, he underwent antibiotic treatment. The lesions improved 3 months after antibiotic treatment, but biopsy specimens showed residual lymphoma cells. The patient therefore received combination chemotherapy with rituximab. Endoscopy 4 months later showed regression of FL, and there was no evidence of recurrence during 3 years of follow up. The partial regression of duodenal lesions of intestinal FL may be due to the effect of antibiotic treatment.
一位 51 岁男性因十二指肠淋巴瘤病变被转诊至我院。内镜检查显示十二指肠第二段（包括 Vater 乳头）存在多个微小、光滑、灰白色颗粒。活检标本显示中等大小的中心细胞样细胞形成淋巴滤泡，免疫组化显示 bcl-2 和 CD10 阳性染色。小肠系列检查显示多个颗粒状病变从十二指肠第二段延伸至近端空肠和回肠近端。根据这些发现，肿瘤被诊断为 I 期滤泡性淋巴瘤（FL）。尽管该患者幽门螺杆菌检测阴性，但仍接受了抗生素治疗。抗生素治疗 3 个月后，病变有所改善，但活检标本显示仍有淋巴瘤细胞残留。因此，患者接受了利妥昔单抗联合化疗。4 个月后的内镜检查显示 FL 消退，3 年随访期间无复发迹象。肠道 FL 的十二指肠病变部分消退可能与抗生素治疗的效果有关。
